The role of isolation of the patients on hospital admission for prevention of nosocomial infections

Abstract

Objective: Contact precautions (CP) for the prevention of multidrug-resistant organisms (MDROs) in endemic countries is a critical element of infection control (IC) practices. In this study, we assessed the effectiveness of empiric CP on admission to the hospital in an MDRO endemic region. Methods: The study was carried out in a 300-bed private hospital from January 2016 to September 2018. The CP indications on the day of hospital admission were decided based on determining risk factors such as long term care patients (Group 1), patients with catheters and/or interventions (Group 2), transferred from another hospital (Group 3), patients with known colonisation with MDRO (Group 4), patients with other risk factors (Group 5). Results: In total, 539 consequent patients were observed. The mean age was 63.4 years, and 57% of the patients were male. Most of the patients were from Turkey (94%); however, the rest were mainly from Middle-Eastern and North-African countries. Among 101 out of 539 (18.7%) patients, at least one pathogen was grown, and among 73 out of 539 patients (13.5%), CP requiring pathogen was isolated. The CP requiring pathogens were detected in group 2 (24%), group 1 (19.4%) and group 3 (13%). The most common pathogens were ESBLproducing Enterobacterales (5.8%), carbapenemase-producing Enterobacterales (3.9%), Pseudomonas spp. (3.53%), Acinetobacter spp. (2.97%), vancomycin-resistant enterococci (2.6%) and methicillin-resistant Staphylococcus (1.86%). Conclusion: Risk assessment-based isolation precautions from the day of hospitalisation in an MDRO endemic country were found to be important among high-risk patients such as patients with catheters and/or interventions, long-term care patients and patients transferred from another medical centre. Implementation of risk-based CP than the culture-based IC strategies might be an effective approach in an MDRO endemic region while pending culture results.